Have you ever received an X-Ray, MRI, or CT scan that shows worse results than you expected? You now know that you have disc bulging, osteoarthritis, disc degeneration, scoliosis, and osteophyte growth in your spine. These results are quite alarming to you and you feel the only thing you can do is have surgery to repair all of this damage. The surgery repairs the disc bulging and shaves off the osteophytes. The surgery is deemed a complete success. The only problem is that you still have the exact same pain you had before the surgery. How can this happen if the surgery repaired everything wrong with my spine?
VOMIT: Victims Of Medical Imaging Technology.
VOMIT is an acronym used to describe the negative role that medical imaging can have on a person. Many patients have instant fear and identification of pain due to the findings on their imaging. Every time there is some type of pain present, the patient can refer back to the disc bulges and disc degeneration as the cause of their pain. While these can be the pain generators, there are others factors that can cause pain.
The table above shows the prevalence of different radiographic findings in different age groups of ASYMPTOMATIC patients. This means that these people in this study had no complaint of any pain in their spine. At the age of 50, 80% of ASYMPTOMATIC patients showed degeneration in their discs.At the age of 40, 50% of ASYMPTOMATIC patients showed disc bulging. 50% of 40 year olds had disc bulges (precursor to a disc herniation)even though they did not have any pain. Now if a 40 year old patient came for an MRI with low back pain and it showed disc degeneration and disc bulging, a surgeon could say that having surgery would be the best course of action. This surgery would correct the disc bulging and disc degeneration, but if that is not the pain generator then it will make no difference in the patient's symptoms.
If you have low back pain and go for an MRI and it shows some of the impressions seen above, you should be conscious that these may not be the sources of your pain. Most back pain can be alleviated without the use of injections, medication, or surgery through the use of time, movement, and lifestyle changes. We recommend avoiding surgery in most cases until every other treatment modality has been exhausted.
Imaging, such as X-Ray, MRI, or CT scans, are used as a tool to help determine the cause of pain. This is not to say that imaging is not important though. A thorough history and physical exam are arguably more important to determine a patients pain generator than imaging.
At THWC we are by no means against having musculoskeletal surgery, but conservative care should be exhausted prior to taking the next steps.